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In this scenario a 28-year-old woman in active labor has just arrived at the labor ward. The woman is persistently coughing, feels warm, and is generally showing mild symptoms of Covid-19. She has regular and intensive contractions and birth is imminent. Upon arrival, the woman was triaged and moved with her partner to a birthing suite under isolation. The simulation will start when the woman is about to give birth in the delivery room. She is observed coughing and with a febrile appearance, but no physical assessment has been done.

Learning objectives

After simulation the participants should be able to:

Don PPE according to guidelines

Recognize symptoms of Covid-19

Assist a woman with suspected Covid-19 in the normal delivery of a healthy baby Maintaining high hygiene standard and infection prevention

Preserve respectful care and women's rights throughout labor and birth

This scenario presents a 55-years-old male presenting in the emergency room with fever, coughing and generally feeling unwell. He returned from travel in an endemic area for COVID-19 1 week ago. The front desk has prioritized him to immediate examination and isolation.

The participants are expected to prepare equipment, don PPE, assess patients and triage to home quarantine, educate patients, communicate effectively with interprofessional team, escalate standard precautions for all patients and safely dispose of equipment and PPE.

Learning objectives:

Recognize the suspected patients early and rapidly

Apply appropriate source control

Apply routine Infection Prevention and Control (IPC) for all patients

Collaborate and communicate with the health care facility’s IPC infrastructure

Apply standard precautions according to presumed diagnosis at all times

Perform a primary assessment of a patient with a suspected acute respiratory infection

This scenario presents the expected arrival of a 71-years-old male with suspected COVID-19. The patient called the healthcare triage call center, with high fever, coughing, chest pain, and respiratory difficulty. 9 days ago, he met with his son who has now been tested positive for 2019-nCoV. The patient has a history of diabetes 2 and chronic liver disease.

This scenario presents a 71-years-old male with suspected COVID-19 already admitted to the Emergency Department. The patient was admitted to 1 hour ago and is waiting for an Intensive care bed.

The participants are expected to assess and recognize deterioration in the patient's respiratory condition. They should appropriately increase ventilatory support while maintaining appropriate respiratory precautions., and recognize the need for intubation and ventilator support.

Learning objectives - After the simulation, the participants should be able to:

Perform a primary assessment of a patient with severe acute respiratory infection (SARI)

Change the non-invasive support to maximize the patient’s effort

Express the need for intubation of the patient to stabilize respiration

This scenario presents with a 71-years-old male with suspected COVID-19 who was admitted from the Emergency Department with Severe Acute Respiratory Infection (SARI). Over 4 hours ago he was transferred to the Intensive Care Unit in an isolation bay.

The participants are expected to assess the patient's work of breathing, identify respiratory dyssynchrony, perform respiratory interventions and recognize the need for sedation to maximize the ventilation for the patient. The participants should communicate with the patient and follow isolation protocols including donning and doffing PPE for contact precaution.

Learning objectives:

Apply standard precautions according to presumed diagnosis including appropriate PPE

Perform a primary assessment of a patient with severe acute respiratory infection (SARI)

Improve ventilation by changing ventilator settings

Discuss concerns with the team in relation to increased respiratory dyssynchrony

This scenario presents a 71-years-old male with diagnosed COVID-19, who was triaged from the Emergency Department and transferred to the Intensive Care Unit in an isolation bay two days ago.

The participants are expected follow isolation protocols, including PPE for contact precaution. They should assess the patient’s saturation status, discuss proper respiratory treatment and recognize the need for turning the patient into a prone position. The participants should delegate roles, utilize closed-loop communication and successfully turn the sedated and paralyzed patient in one movement.

NOTE: This scenario contains an optional alternative partway with accidental extubation of the patient while turning him to prone position. The participants should then recognize the unintentional emergency incident and act immediately by reversing the patient to supine position, apply cricoid pressure, reintubate the patient and reconnect to a ventilator.

Learning objectives:

Apply standard precautions according to presumed diagnosis including appropriate PPE

Perform a primary assessment of a patient with COVID-19 respiratory infection (SARI).

Realize the need to turn a patient into prone position

Verify sedation and paralysis prior to changing the position of a patient

Delegate roles and communicate with team members to move a patient in one movement

Perform turning of a sedated and paralyzed patient while on a ventilator

Resuscitation scenarios:

In this scenario, the participants will encounter a patient, who has collapsed in the hallway of the local university. During simulation, he experiences a cardiac arrest with a non-shockable rhythm. The participant should don Personal Protective Equipment (PPE) according to guidelines prior to patient interaction and the team should consider how to limit the use of aerosol generating procedures during resuscitation. After ROSC, the participants should consider transport the hospital and driving personnel should doff PPE according to guidelines.

In this scenario, the participants will encounter a patient with suspected Covid-19 who collapses during a visit to the local grocery. During simulation he experiences a cardiac arrest with a shockable rhythm. The participant should don Personal Protective Equipment (PPE) according to guidelines prior to patient interaction and the team should consider how to limit the use of aerosol generating procedures during resuscitation. After ROSC, the participants should consider transport to the hospital and driving personnel should doff PPE according to guidelines.

In this scenario, the participants will encounter a patient who is home-quarantined with suspected Covid-19. During the simulation the patient will experience a cardiac arrest with a non-shockable rhythm.

The participant should don Personal Protective Equipment (PPE) according to guidelines prior to patient interaction and the team should consider how to limit the use of aerosol generating procedures during resuscitation. After ROSC, the participants should consider transport to the hospital and driving personnel should doff PPE according to guidelines.